DEVELOPING A UNIQUE ADVANCED PHARMACY PRACTICE EXPERIENCE:

CLINICAL TELEPHARMACY THROUGH TELECOMMUNICATION AND TELEPRECEPTING

Tiffany Ma PharmD Candidate 2020Phil Bettis PharmD Candidate 2020, Lindsey Hunt, PharmD, BCPS, Laura Spoutz, PharmD, BCPS,

& Danielle Ahlstrom, PharmD, BCPS

ISU/UAA College of Pharmacy – Anchorage, AK CampusBoise Veterans Affairs Medical Center – Boise, ID

DISCLOSUREI am the remote student in this presentation and completing this rotation was a requirement for both my college of pharmacy and for licensure with the state of Alaska. However, I have no relevant

financial relationships to disclose.

Pretest

■ Can an APPE rotation successfully be completed in its entirety remotely via telecommunication and teleprecepting? True or False?

■ Which is NOT a barrier to successfully completing an APPE via telecommunication?– A. Time zone differences– B. Technical and/or connectivity issues– C. Political differences

■ What would you consider to be an absolute requirement for an APPE to be considered successful?

OBJECTIVE Upon conclusion of the program, the participant should be able to

describe how an APPE rotation can be completed by a remote student entirely through teleprecepting and telecommunication.

Background• The Veterans Integrated Service Network 20 (VISN 20) telehealth APPE

• Well-practiced model of clinical pharmacy care to remote locations• Onsite students experience telehealth as practicing clinical telehealth pharmacist

• The novel idea to offer this experience entirely via telecommunication to a remote student was unprecedented.

• The remote student is part of an inaugural PharmD program in Alaska• A unique APPE to learn about telehealth pharmacy practice

PURPOSEThis rotation was designed to offer the complete advanced pharmacy

practice experience (APPE) to an inaugural pharmacy student located in Anchorage, Alaska, in its entirety through the innovative route of

telecommunication and teleprecepting.

Methods• EverydaytheremotestudentmetviatelecommunicationwithapreceptorlocatedinBoise

• Thestudentattendedmeetings,topicdiscussions,andstudentpresentations;presentedtopicdiscussions,ajournalclub,andaclinicalcase;shadowedproviders,answereddruginformationquestions,conductedpatientappointments,andwroteprogressnotes,allthroughtelecommunication.

• Thestudentcompletedvariousprojectsacrossthecontinuum,suchasastudent-derivedposterandastudent-specifictelehealthAPPEguidebook.

• Asameasuretoestablishparitybetweenthestudentexperiences,adetailedcomparisonofeachstudents’schedulewasexaminedattheendoftherotation.

• Duetotheuniquecircumstancesoftheremotestudent’sonboardingschedule,accesstopatientinformationwasnotgranteduntiltheendofweektwoandthecomparisonbetweenstudentschedulesbeganthen.

Onsite Student Remote Student 4 presentations 5 presentations

4 topic discussions 9 topic discussions

1 drug information q’s 3 drug information q’s

4 electronic consult q’s 5 electronic consult q’s

5 clinical pharm meetings 9 clinical pharm meetings

10 provider shadows 8 provider shadows

27 appts conducted 16 appts conducted

35 no show appts 9 no show appts

2 lost appts to technical issues 3 lost appts to technical issues

Results

Results

For both students, the types of patient appointments weighed heavily in diabetes, then tobacco cessation, and least in other chronic conditions.

Appointment types were recorded according to initial chief complaints and did not always accurately reflect all the disease states actually addressed in each visit.

Discussion• Where the results show more exposure to direct

patient contact and no show appointments for the onsite student, the remote student had more exposure to drug information/electronic consults questions, topic discussions, presentations, projects, and pharmacy/clinical pharmacy meetings.

Conclusion• Teleprecepting a remote student via telecommunication proved to be

successful in delivering an APPE experience comparable to an onsite student in exposure to types of disease states and overall clinical telepharmacy practice.

FUTURE CONSIDERATIONS

Improvements to technological barriers and increased exposure to direct patient care appointments could make the remote and onsite student experiences

indistinguishable in the future.

Post Test

■ Can an APPE rotation successfully be completed in its entirety remotely via telecommunication and teleprecepting? True or False?

■ Which is NOT a barrier to successfully completing an APPE via telecommunication?– A. Time zone differences– B. Technical and/or connectivity issues– C. Political differences

■ What would you consider to be an absolute requirement for an APPE to be considered successful? Self relfection

SPECIAL THANKS• VISN 20 telehealth pharmacist preceptors for accommodating and

providing a unique APPE rotation to the remote student under particularly special circumstances.

• ISU, especially Dr. Tom Wadsworth & Dr. Paul Black, for your tireless efforts to deliver excellent student opportunities!